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Tongue Carcinoma

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1641. Hoarseness

[ ] Smoking (also the main risk factor for laryngeal carcinoma). Excess alcohol consumption. Gastro-oesophageal reflux. Professional voice use - eg, teachers, actors and singers. Environment: poor acoustics, atmospheric irritants and low humidity. Type 2 diabetes (neuropathy, poor glycaemic control). [ ] Anatomy and physiology [ ] Sound is produced in the larynx by vibration of the vocal cords. Resonance occurs in the pharynx, nose and mouth; articulation uses the mouth and tongue. Coughing requires (...) to exclude malignancy : [ ] Carcinomas of larynx and lung must be considered, so CXR and/or laryngoscopy are indicated. National Institute for Health and Care Excellence (NICE) guidance on suspected cancer states that for patients with hoarseness persisting for >3 weeks, particularly smokers aged ≥50 years and heavy drinkers: Arrange urgent CXR. Refer patients with positive findings urgently to a team specialising in the management of lung cancer. Refer patients with a negative finding urgently to a team

2008 Mentor

1642. Human Herpes Viruses

of the nasopharynx; (common Chinese and Southeast Asian manifestation) cells contain latent virus. Viral replication in the superficial layers of the tongue epithelium results in a benign lesion, almost exclusively in HIV-positive individuals. See links in the table for further information. EBV has also been associated with other diseases, including: EBV-associated gastric carcinoma [ ] . Several autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis and multiple sclerosis. However (...) . ; Epstein-Barr Virus (EBV)-associated gastric carcinoma. Viruses. 2012 Dec4(12):3420-39. ; Epstein-Barr virus in systemic lupus erythematosus, rheumatoid arthritis and multiple sclerosis-association and causation. Viruses. 2012 Dec4(12):3701-30. ; Roseola infantum and its causal human herpesviruses. Int J Dermatol. 2014 Apr53(4):397-403. ; A population-based study of primary human herpesvirus 6 infection. N Engl J Med. 2005 Feb 24352(8):768-76. ; Human herpesvirus 6 encephalitis. Curr Infect Dis Rep

2008 Mentor

1643. Multiple Endocrine Neoplasia Type 2 (MEN 2)

usually predate MTC and phaeochromocytoma. Almost all patients have a Marfan's-like habitus, usually associated with skeletal abnormalities, particularly slipped femoral epiphysis. MEN2B disease is also characterised by the development in early life of multiple mucosal neuromas. Neuromas are commonly ocular and oral, causing whitish-yellow or pink nodules on the anterior aspect of the tongue, lips and eyelids, with thickening of the mucosa and often eversion of the lower lids. Neuromas appear (...) as: [ ] Glistening bumps around the lips, tongue and lining of the mouth. Bumps on the eyelids, which are often thickened - neuromas may also appear on the cornea and conjunctiva. Intestinal ganglioneuromatosis affects about 75% of cases. Neuromas involve the autonomic nerves of both the myenteric and submucosal plexi and can cause poor suckling, with failure to thrive, constipation, diarrhoea, recurrent pseudo-obstruction, toxic megacolon and, occasionally, dysphagia and vomiting, possibly due to achalasia

2008 Mentor

1644. Menorrhagia

). Endometrial hyperplasia or carcinoma. Endometrial carcinoma presents in women aged over 50 years in the majority of cases and classically with postmenopausal bleeding; however, some cases present with abnormalities of the menstrual cycle. 90% present with abnormal uterine bleeding in some form [ ] . Systemic disease can include hypothyroidism, liver or kidney disease, obesity and bleeding disorders - eg, von Willebrand's disease. An intrauterine contraceptive device (IUCD) or anticoagulant treatment can (...) medical problems, including clotting disorders, thyroid status and gynaecological history. Ask about easy bruising or bleeding gums. Examination Clinical examination should be undertaken to assess for any anaemia and also to rule out potential organic causes of menorrhagia. Note general appearance and BMI. Body fat is very important in relation to metabolism of steroid hormones. Note any signs suggestive of endocrine abnormality (hirsutism, acne) or bruising. Look at the tongue for pallor

2008 Mentor

1645. Cerebellar Signs including Cerebellar Ataxia

with malnutrition. May improve with thiamine. May also occur with other deficiencies, including zinc and vitamin E. Other causes include: Ingestion of drugs - especially anticonvulsants, particularly phenytoin (may reverse once the drug is stopped). Solvent abuse. Heavy metals. Structural lesions. Paraneoplastic cerebellar degeneration associated with carcinomas of the lung or ovaries. CJD (rare). Other signs Cerebellar dysarthria Cerebellar disease can produce a spluttering staccato speech. Scanning dysarthria (...) , and linguistic abilities, with affective disturbance ranging from emotional blunting and depression, to disinhibition and psychotic features. Examination Check eye movement - looking for ophthalmoplegia or nystagmus. Check fundi for papilloedema. Get the patient to stick his/her tongue out and move it from side to side (movement slowed). Ask the patient to repeat "baby hippopotamus" - look for dysarthria and abnormal speech rhythm and syllable emphasis. Examine arms for limb ataxia (see above): rebound

2008 Mentor

1646. Chorea

. The arms, legs, neck and tongue may also be affected. Causes include asphyxia, neonatal jaundice, Huntington's chorea, cerebrovascular disease and trauma. Management can be difficult but treatment options include medications (eg, diazepam, haloperidol, tetrabenazine), surgery and retraining techniques. Chorea Continuous jerky movements in which each movement is sudden and the resulting posture is held for a few seconds. This usually affects the head, face or limbs. The focus may move from one part (...) , hypomagnesaemia, hypocalcaemia, hepatic and renal failure. Vitamin deficiency: B1 and B12. Paraneoplastic syndromes - eg, small cell carcinoma of the lung, renal cell carcinoma, ovarian cancer and lymphoma. Postoperative - following childhood cardiac surgery ('post-pump choreoathetosis'). Other CNS conditions: trauma (including cerebral palsy), intracranial tumours. Senile chorea. Ventriculoperitoneal shunts. Toxins - eg, carbon monoxide, cyanide, alcohol, methanol, solvents, thallium, mercury and manganese

2008 Mentor

1647. Salivary Gland Tumours

Guidelines. You may find one of our more useful. In this article In This Article Salivary Gland Tumours In this article The major salivary glands are the parotid glands, submandibular glands and sublingual glands. There are also a large number (600-1,000) of minor salivary glands widely distributed throughout the oral mucosa, palate, uvula, floor of the mouth, posterior tongue, retromolar and peritonsillar area, pharynx, larynx and paranasal sinuses. Tumours affecting salivary glands may be benign (...) or malignant and are diverse in their pathology. About 80% of salivary gland tumours occur in the parotid gland. [ ] Classification Malignant tumours The malignant tumours most commonly affecting the major salivary glands are mucoepidermoid carcinoma, acinic cell carcinoma and adenoid cystic carcinomas. Among the minor salivary glands, adenoid cystic carcinoma is the most common. Malignant tumours are designated high-grade or low-grade dependent on their histology. High-grade Mucoepidermoid carcinoma

2008 Mentor

1648. Problems in the Mouth

are squamous cell carcinomas): May present as a persistent ulcer (see box, above). Autoimmune conditions: . . . . . . . Inflammatory conditions: . . Reactive arthritis ( ). Drugs: Chemotherapeutic agents. Others, including non-steroidal anti-inflammatory drugs (NSAIDs), dactinomycin, gold salts, nicorandil. Inherited conditions: . Various miscellaneous conditions: Haematological disease, notably , and Strachan's syndrome. Sweet's disease. Aphthous ulcers These are also referred to as canker sores, aphthous (...) irritation, . Drugs - broad-spectrum antibiotics and inhaled/oral corticosteroids. Symptoms Pain - may make eating and drinking difficult. Altered sense of taste - sometimes. May be asymptomatic. Signs There are several clinical forms of oral candidiasis. Other causes of sore mouth Burning mouth syndrome (BMS) This idiopathic condition is characterised by a burning sensation in the tongue or other parts of the mouth in the absence of medical or dental causes. Exclude local and systemic factors

2008 Mentor

1649. Beckwith-Wiedemann Syndrome

ultrasound. [ ] Suspicious features include: Increased abdominal circumference. Large kidneys. Large placenta, raised amniotic fluid volume. Protruding tongue. Large-for-gestational-age fetus. Raised alpha-fetoprotein with omphalocele. Symptoms Hypoglycaemia. Poor feeding. Lethargy. Problems with breathing, eating and speech, relating to the severity of macroglossia. Signs Growth Large for gestational age; the overgrowth in BWS is often the result of increased IGF2 action in the tissues. Birth weight (...) General measures Screening for tumours: [ ] The child should have alpha-fetoprotein levels (marker for hepatoblastoma) monitored until 4 years old. Repeated abdominal ultrasound scans until 8 years old. Hypoglycaemia: Screening for hypoglycaemia should be undertaken in the first few days of life. [ ] Hypoglycaemia should be rigorously avoided and treated, when necessary. Diazoxide can be used to inhibit insulin secretion. Surgical If the tongue protrudes and interferes with speech and dental

2008 Mentor

1650. Bulbar and Pseudobulbar Palsy

of the oral cavity need to be used: Larynx Pharynx Palate Tongue Lips Along with this, controlled expiration is required, so that air can be released at the appropriate speed and in appropriate amounts. Neurological control of normal speech The above structures required for speech are controlled by the nervous system. Corticobulbar tracts from both of the motor cortices send signals down to the nuclei of the following nerves: Vagal nerve Facial nerve Hypoglossal neve Phrenic nerve The motor aspects (...) in speech, ie the pharynx, palate, tongue and lips. These muscle contractions change the vocal sounds from the larynx, thus resulting in noises recognised as words. Larynx - produces vowels and some consonants. Lips - produce m , b and p . Lingula - l and t . Throat and soft palate (guttural) - nk and ng . Disorders of articulation [ ] This is also called dysarthria or anarthria. There are several causes: Bulbar palsy Pseudobulbar palsy Cerebellar-ataxic Hypokinetic Hyperkinetic Cerebellar-ataxic

2008 Mentor

1651. Abnormal Involuntary Movements

, hands, toes and feet. The arms, legs, neck and tongue may also be affected. Causes include asphyxia, neonatal jaundice, Huntington's chorea, cerebrovascular disease and trauma. Management can be difficult but treatment options include medications (eg, diazepam, haloperidol, tetrabenazine), surgery and retraining techniques. Chorea Continuous jerky movements in which each movement is sudden and the resulting posture is held for a few seconds. This usually affects the head, face or limbs. The focus (...) , hyperglycaemia and hypoglycaemia, hypomagnesaemia, hypocalcaemia, hepatic and renal failure. Vitamin deficiency: B1 and B12. Paraneoplastic syndromes - eg, small cell carcinoma of the lung, renal cell carcinoma, ovarian cancer and lymphoma. Postoperative - following childhood cardiac surgery ('post-pump choreoathetosis'). Other CNS conditions: trauma (including cerebral palsy), intracranial tumours. Senile chorea. Ventriculoperitoneal shunts. Toxins - eg, carbon monoxide, cyanide, alcohol, methanol, solvents

2008 Mentor

1652. Xeroderma Pigmentosum

). These are solar keratoses (premalignant), squamous cell carcinoma (SCC), basal cell carcinoma (BCC) and malignant melanoma. BCC and SCC occur most frequently. They are more prevalent in areas exposed to sun. The anterior tongue is also vulnerable. Eye features [ ] Eye features occur in the anterior, exposed part of the eye: Photophobia. Conjunctival inflammation and keratitis. Severe keratitis can lead to corneal opacification and vascularisation. Tumours of conjunctiva and eyelids - benign or malignant

2008 Mentor

1653. Swallowed Foreign Bodies

, vomiting, drooling, wheezing, blood-stained saliva, or respiratory distress. [ ] Oropharyngeal foreign bodies Overall, about 60% of foreign bodies become trapped at this level (commonly at, or just below, the level of the cricopharyngeus muscle). Patients usually have a clear sensation of something being trapped that is relatively well localised. Small linear items such as bones and toothpicks are often trapped at this level, from the tonsils/posterior tongue to the vallecula and upper oesophagus (...) scenario is unlikely to be confused with another illness, with the possible exception of space-occupying oesophageal pathology - eg, oesophageal carcinoma causing obstruction of a normal food bolus. Always consider the possibility that a foreign body has been inhaled, particularly if a patient presents acutely with respiratory compromise or with chronic chest symptoms. An acute presentation of mediastinitis may be due to perforation by a swallowed foreign body, or the primary form of the disease. can

2008 Mentor

1654. Thyroglossal Cysts

within the tongue. Suprasternal cysts: Fewer than 10% of cases. Intralaryngeal cysts: Very rare. These must be differentiated from other intralaryngeal lesions. Epidemiology TGC was reported as the most common cause of congenital neck swelling (53%) in a Jordanian study. [ ] They may be found in as many as 7% of the population. [ ] Most commonly, they present in the first decade of life. They are, however, also seen in adults. [ ] Presentation TGCs usually present as fluctuant swellings (...) in the midline of the neck along the line of thyroid descent. NB : it is important to note that the cyst moves upwards when the patient protrudes the tongue. This occurs because it is attached to the thyroglossal tract which attaches to the larynx by the peritracheal fascia. Other features: TGCs are usually non-tender and mobile. Infected TGCs may present as a tender mass. A tender infected TGC may be associated with dysphagia, dysphonia, draining sinus, fever or increasing neck mass. An infected TGC may

2008 Mentor

1655. Otalgia

- adenoidectomy, infection or neoplasm Cranial nerve referred pain (eg, Vth cranial nerve - , VIIth cranial nerve - , glossopharyngeal or cranial nerve - ) Teeth and jaw - impaction of molars, malocclusion, arthritis Base of skull - elongated styloid process Petrous aneurysms Oesophagus - foreign body, or Inflammation or neoplasm of oropharynx, tongue or larynx Epidemiology Otalgia is very common, especially in children, and most cases are transient [ ] . Approach to the patient with otalgia History (...) - especially pertaining to onset, and precipitating factors - eg, noise, duration, discharge, fever, swallowing disorder, dental history. Examination - auroscopy looking for causes - eg, otitis media, cerumen. If auroscopy is unremarkable, consider referred causes of pain and examine the cranial nerves, especially V, IX and X. Also examine - the nose, sinuses, oropharynx and nasopharynx (occult carcinoma often presents with otalgia), TMJ , parotid glands, larynx, and trachea. Check temperature

2008 Mentor

1656. Oropharyngeal Tumours

Guidelines. You may find the article more useful, or one of our other . In this article In This Article Head and Neck Cancers In this article Squamous cell carcinoma (SCC) represents more than 90% of all head and neck cancers. The majority of cancers of the head and neck arise from the surface layers of the upper aerodigestive tract (UAT). UAT cancers include: , which include tumours of the buccal mucosa, retromolar triangle, alveolus, hard palate, anterior two thirds of the tongue, floor of the mouth (...) , and the mucosal surface of the lip. [ ] : Cancers of the oropharynx, which include tumours of the base of the tongue, the tonsil and the under surface of the soft palate. [ ] Cancers of the hypopharynx (bottom part of the throat), which include tumours of the postcricoid area, pyriform sinus and the posterior pharyngeal wall. [ ] Cancers of the nasopharynx (behind the nose). . Other UAT sites include the salivary glands, nose, sinuses and middle ear but these cancers are relatively rare. Cancer originating

2008 Mentor

1657. Oral Ulceration

common cause of oral mucosal ulceration. It is most often caused by dentures, braces or sharp/broken teeth. It can also be due to tongue or cheek biting, scratching with fingernails, or eating rough foods. Any ulcer usually starts to heal within 10 days following removal of the cause. Persistence after the presumed cause has been removed should lead to urgent further investigation. Chemical injury This can arise from direct contact of oral mucosa with aspirin (leaving white plaques which slough off (...) is most commonly affected, these injuries can also occur on the lip, tongue or oropharyngeal region. Recurrent aphthous ulceration [ , ] These are also known as 'canker sores'. The condition is characterised by clearly defined, painful, shallow round or ovoid ulcers not associated with systemic disease. They are not infective. They usually begin in childhood and decrease in frequency/severity with age. Around 40% of cases have a family history. In predisposed people, the following may precipitate

2008 Mentor

1658. Mucosal neuroma syndrome--a phenotype for malignancy. (Full text)

Mucosal neuroma syndrome--a phenotype for malignancy. The mucosal neuroma syndrome is characterised by a typical physical appearance, neuromata on tongue and buccal mucosa, and a high risk of developing medullary thyroid carcinoma and phaeochromocytoma. A case is described and the importance of early recognition for prevention of malignancy is stressed.

1985 Archives of Disease in Childhood PubMed abstract

1659. Immunocytochemical identification of epithelium-derived human tumors with antibodies to desmosomal plaque proteins. (Full text)

Immunocytochemical identification of epithelium-derived human tumors with antibodies to desmosomal plaque proteins. Epithelial cells contain desmosomes, special intercellular junctions providing sites of membrane attachment for intermediate-sized filaments of the cytokeratin type (tonofilaments). Such sites of anchorage of tonofilaments appear as dense plaques on the cytoplasmic side of the desmosomal membrane. We have isolated desmosome-enriched fractions from bovine snout epidermis and tongue (...) at the light and electron microscope levels, we show that these antibodies bind specifically to desmosomal plaques. Antibodies to desmoplakins have been used successfully for detection of desmosomal proteins in a broad variety of epithelium-derived human tumors, including primary carcinomas and their metastases, irrespective of the morphology of the specific tumor. Nonepithelial tumors examined have been negative. We propose to use antibodies to desmoplakins and to cytokeratins in pathological diagnosis

1983 Proceedings of the National Academy of Sciences of the United States of America PubMed abstract

1660. An immunoradiometric assay of tumour-antigen 4 (TA-4): a comparison with conventional radioimmunoassay. (Full text)

An immunoradiometric assay of tumour-antigen 4 (TA-4): a comparison with conventional radioimmunoassay. The serum level of tumour-antigen 4 (TA-4) was measured in 181 patients with squamous cell carcinoma (SCC) of various organs (71 lung, 24 uterus, 16 oesophagus, 64 head and neck and six skin), 34 patients with other types of lung cancer and 35 patients with benign diseases. To compare the results with those obtained by the conventional competitive radioimmunoassay (RIA) using a polyclonal (...) higher with the IRMA method than with the RIA method in SCC of all organs, as much as 2-3 times higher in SCC of the larynx, tongue and pharynx. In contrast, in patients with benign diseases or other types of lung cancer, there was no difference in the positive ratios between the two methods. This was largely due to the improvement in sensitivity and accuracy of assay with the new method, which resulted in a decrease in the normal value in healthy controls. It was concluded that with the new IRMA

1990 British journal of cancer PubMed abstract

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